SIL as seen by the Joint Standing Committee

When the JSC’s Inquiry into SIL was conceived nine months ago, the particular focus was on:

the approval process for access to SIL;
the vacancy management process, including its management and costs; and
the funding of SIL.

There was also a delicious little kicker of “any related issues” added in to see what other concerns people or organisations might want to raise.

The JSC runs parliamentary enquiries into the performance of the NDIS. It consists of 5 Senators and 5 Members of Parliament.

After an appropriate gestation period, the committee’s SIL Report was born weighing in at a healthy 175 pages. In case you missed it, here are some key takeaways.

The super short version is that the committee acknowledges that SIL is not working very well and is causing a lot of pain for many NDIS participants, family members and service providers. None of that is likely to surprise anyone with more than a passing interest in SIL. The committee made 45 recommendations that they think will lead to some improvements. And if all you want is the Readers’ Digest version of the Report, read the executive summary.

The slightly longer version is that there are eight chapters, each broken into several themes or topic areas.

Chapter 1: Overview
Chapter 2: Background
Chapter 3: SIL
Chapter 4: Approval process for access to SIL
Chapter 5: Living arrangements for SIL participants
Chapter 6: Vacancy management
Chapter 7: Funding for SIL
Chapter 8: Other issues

If you want to dig into the detail on any of the main focus areas relating to the SIL, have a read of what’s most relevant to you. It’s probably in chapters four to seven. Chapters one to three set the scene, and chapter eight deals with the “related issues”. It is worth noting that the living arrangements for SIL participants sneaks in with a chapter in its own right despite not being identified as an area of ‘particular focus’.

The first page of the executive summary makes several statements and connections that may provide us with some potential signposts for future directions of SIL:

While only 6.6% of participants receive SIL funding, it represents 31% of total funding under the NDIS. You don’t need to be an accountant to conclude that that sort of ratio is unlikely to be sustainable.
The committee identifies the link between SIL and pre-NDIS state-funded models that linked supports with residency in group homes in which people with disability had limited choice about who provided their supports or who they lived with.
The next paragraph notes that “those arrangements are coming to an end, and more individualised funding models are being developed under the NDIS.” While SIL is identified as one such model, the report states that “the current SIL regime suffers from various issues with the potential to undermine choice and control for participants and the financial viability of providers. These issues are of particular concern given the significant portion of NDIS funding committed to SIL supports, and the fact that a substantial portion of participants accessing SIL have higher or more complex needs” (p. xv).
The NDIA explicitly comments on the link between pre-NDIS state-funded models, SIL and future approaches on page 73: “While the approach to SIL has to date been shaped by service models established under the former state-based funding framework, the agency is committed to service innovation and improvement as the NDIS matures. … in the future, approaches to SIL funding will move away from legacy models of support and will be driven by the participant's goals and support needs, contemporary support models, evidence and actuarial data.”

If you’re a SIL provider wanting to position yourself on the leading edge of best practice, that’s a pretty explicit signpost about how you need to develop and shape your services.

Concerns about participant choice and control permeate the entire report. These concerns start on the first page of the executive summary, repeatedly appear in every chapter and receive explicit attention as an issue in their own right under ‘decision support and advocacy’ in chapter eight. If you’re a SIL provider, it is worth reading the report through this lens. We know that the NDIA Board and senior leaders are concerned about SIL. So, where might they take it if our lawmakers are expressing the same concern?

Choice and control and eligibility:

The committee expressed concern that the current eligibility process for SIL may effectively commit participants to particular providers and residences, thereby reducing choice and control.

The committee recommends empowering planners to authorise a price range for SIL funding in participants' plans, with no further approval required if a quote from a provider falls within that price range. They state that this “will increase choice and control with respect to participants’ living arrangements, and help streamline and expedite approval processes for access to funding. The committee emphasises that the participant and/or their plan nominee should be able to review and approve the SIL quote before it is approved by the NDIA.” (p. 36).

Choice and control and living arrangements for SIL participantsy:

The committee expressed a concern that the current SIL regime may be encouraging and possibly forcing participants with SIL to live in shared accommodation. They believe this is largely due to legacy arrangements and perceived cost-cutting measures.

The report also adds that the existing SIL framework may exclude participants from having the flexibility to share housing with people without disability. The committee emphasises that all people should have choice and control over their living arrangements, including who they share their home with. This principle is enshrined in international human rights law.

It goes on to note that “the NDIA may promote SIL as the only support option for some cohorts (for example, participants with complex disability or higher support needs). … Participants may have difficulty exiting congregate arrangements due to current processes for assessing whether supports are reasonable and necessary, and that participants are not supported to leave congregate settings where they wish do to so.” (pp. 75-76)

Choice and control and conflicts of interest

The report is extremely blunt about this issue. Take away messages are:

The committee heard about conflict of interest that arises where a provider of supports also owns the property in which supports are delivered.
This concern is heightened when the same provider is also responsible for support coordination.
The committee also heard that allowing a single provider to exercise control over both tenancy and service delivery may have significant negative impacts for participants. This includes a reduction in service quality; increased risks of abuse and neglect; and reduced housing security. In particular, the committee was concerned to hear that participants in these circumstances may not be able to change service providers without risking homelessness.
The committee is concerned that some organisations actively resist the separation of service delivery and tenancy functions.
The majority of submitters and witnesses who gave evidence in relation to this matter emphasised that separating tenancy, service delivery and support coordination is crucial to enabling choice and control for NDIS participants.
The NDIA has also acknowledged these risks. They state that going forward, the separation of these functions will be a key design parameter for SIL and SDA.

The committee believes that the NDIA should progress work to separate tenancy, service delivery and support coordination as a matter of urgency.

You get the picture by now: protecting, enabling and ensuring participant choice and control is a big deal for the committee. So, if what you’re doing gets in the way of participant choice and control, you should sharpen your focus on those things and work out how to do things differently. As we’ve said elsewhere, giving participants maximum autonomy over decision making is ultimately a culture issue, so changing the window dressings won’t cut it. The NDIS is a genuine paradigm shift that pivots on who has the governance authority to make decisions. To fit the NDIS, service models need to preference, authorise and support participants to make as many decisions as possible for themselves.

Some tidbits

Dotted throughout the report, there are also a few delightful tidbits that include these little gems.

The committee heard that “planners may have a tendency not to recommend innovative housing options, due to lack of knowledge about such options and a desire to protect participants by recommending more familiar forms of accommodation”. (P. 41)

Vacancy management is an ongoing issue in which the NDIA has been clear that it is providers’ responsibility to manage vacancies. The committee is indicating that that won’t change and they don’t want to create perverse incentives for providers to maintain vacancies. As such, the committee recommends some partial ‘gap funding’ as a mechanism that might usefully help solve some of the impacts this issue has for providers and participants.

The committee noted that numerous submissions identified that congregate living arrangements are more likely to limit choice and control for people with disability, as well as potentially increasing the risks of social isolation and abuse. The committee noted that this is a view that is widely expressed in the academic and disability support communities.

The committee acknowledged that shared accommodation may result in positive outcomes in some cases, and does not propose to eliminate shared living and support arrangements. However, they noted that delivering positive outcomes in shared arrangements will usually depend on the extent to which participants have a genuine choice as to who they live with and where they live. The committee emphasised that all people should have the right to make informed and genuine choices about their living arrangements.

And one last tidbit to note, “the NDIA … noted that a substantial portion of SIL quotes submitted by providers contain errors, or are not provided to the NDIA in a timely fashion. The NDIA acknowledged that this might be due to the NDIA not providing sufficient clarity around the requirements of the SIL quoting process or the items which may and may not be included in a SIL quote.” (p. 55)

And a puzzling omission.

Spotting what’s missing in reports of this nature can be harder than making sense of what’s included. In this case though, more the half of the country seems to have been missed, which is a fair-sized chunk of Australia to leave out. The JSC didn’t hold any public hearings west of Adelaide or in the Northern Territory. And while at least one person from the NT was invited to provide evidence in person at the Adelaide hearing, it doesn’t seem that anyone from WA appeared at any of the public hearings. Which gets me just a little bit curious to know why, what were they thinking? At this rate, McGowan will order the backhoes to start digging the ditch.